Treatment Side Effects

The most important thing to keep in mind about mesothelioma treatment side
effects is that you should monitor them to be sure that they don’t
increase in severity. Any change in side effects should be immediately
reported to your doctor.

Study Discusses Complications after Extrapleural Pneumonectomy

There is risk for complications with any surgery; however, since extrapleural
pneumonectomy is an extremely complex procedure, the rate of incidence
is higher.

In a study titled
Risk Factors for Major Complications After Extrapleural Pneumonectomy for
Malignant Pleural Mesothelioma, published April 2008 in
The Annals of Thoracic Surgery, researchers examined 62 patients who underwent extrapleural pneumonectomy
for malignant pleural mesothelioma between January 1993 and May 2007.

Their observations led them to conclude that patients who experienced major
complications were older, meaning 60+ years as compared with patients
who were 56 years or younger. The amount of transfused red blood cells
also affected risk for complication. Those who receive more than four
units were at increased risk. Finally, major complications occurred in
54 percent of the procedures performed on the right side as compared with
21 percent performed on the left. As with mesothelioma in general, being
male and having late stage cancer also increased the odds.

Complications were considered to be a result of surgery if they occurred
within 30 days of the procedure or during the same hospital stay. Major
complications were defined as complications of grade 3 or higher according to the
National Cancer Institute Common Terminology Criteria for Adverse Events
3.0 guidelines. They included:

Atrial fibrillation (irregular heart beat)

Cardiac arrest

Pulmonary emboli (obstruction that causes a blood clot in the lungs)

Acute lung injury/pneumonia

Abdominal herniation

Esophageal perforation

Malignant Seeding Can be an Adverse Effect of Surgery

A condition called “seeding” is a common result of surgeries
used for diagnosis, tumor staging and talc pleurodesis. Malignant cells
grow in the tracts created during thoracentesis, a procedure that uses
a puncture through the chest wall either to take a sample of pleural fluid
to diagnosis its cause, or to relieve shortness of breath. It can also
be used for talc pleurodesis. These malignant cells can also grow in biopsy
sites, chest tube sites and surgical incisions.

According to the authors of
Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis and Translational Therapies, “The frequency of malignant seeding, has been reported to occur
in approximately 20% to 50% of mesothelioma patients who undergo these
procedures.” It typically presents as painful nodules below the
skin and is treated with radiation.

In a study titled
Prevention of malignant seeding at drain sites after invasive procedures
(surgery and/or thoracoscopy) by hypofractionated radiotherapy in patients
with pleural mesothelioma, published 2008 in Acta Oncologia, researchers tracked 32 patients diagnosed
with pleural mesothelioma who underwent surgery and/or thoroscopy (procedure
that uses an endoscope to see inside the chest) for diagnosis, staging
or talc pleurodesis. They were treated with external beam radiation therapy
at a dose of 21 Gy (gray) in 3 fractions over one week, meaning the treatment
was spread out over three sessions that took place during the same week.
After completion of radiation treatment, 20 of 32 patients underwent chemotherapy.

The researchers observed that after an average follow-up of 13.6 months
from the end of radiation therapy, no patient experienced disease progression
in the treated area. Seventeen patients died of disease that had progressed
locally after an average survival time of 12.6 months; 13 patients were
alive with disease after an average follow-up of 13.9 months; 2 patients
were alive without evidence of disease after an average follow-up of 16.5 months.

Radiation Side Effects

The American Cancer website says this about adverse effects caused by radiation:

“Side effects of radiation therapy may include fatigue and mild skin
changes that resemble sunburn. These usually go away once treatment is
finished. Chest radiation therapy may cause lung damage and lead to trouble
breathing and shortness of breath. Abdominal radiation therapy may cause
nausea, vomiting, diarrhea, and a loss of appetite.

If radiation therapy is used together with chemotherapy, it may make the
side effects of chemotherapy worse.

If you are having any side effects from radiation therapy, talk with your
doctor. In most cases there are ways to help control these symptoms.”

Chemotherapy Side Effects

The standard combination of chemotherapy drugs used to treat mesothelioma
is cisplatin (Platinol) and pemetrexed (Alimta). If the patient is unable
to tolerate cisplatin, carboplatin, a chemotherapeutic agent from the
same drug class, is substituted.

In a study titled
Randomized phase II trial of pemetrexed combined with either cisplatin
or carboplatin in untreated extensive-stage small-cell lung cancer, published October 20, 2006 in the
Journal of Clinical Oncology, researchers evaluated 78 patients enrolled in this clinical trial from
December 2002 to May 2004.The patients were randomly assigned to receive
either cisplatin/pemetrexed (average age of patients in this group was
63 years old) or carboplatin/pemetrexed (average age of patients in this
group was 66 years old).

The chart below lists the type of adverse effect and the percentage of
patients who experienced it broken down by drug combination:

Cisplatin/pemetrexed

Anemia – 10.5 percent

Neutropenia (low white blood cell count) – 15.8 percent

Thrombocytopenia (low platelet count) – 13.2 percent

Shortness of breath – 5.3 percent

Nausea – 15.8 percent

Vomiting – 7.9 percent

Nervous system toxicity – 15.8 percent

Diarrhea – 2.6 percent

Fatigue – 10.5 percent

Carboplatin/pemetrexed

Anemia – 5.7 percent

Neutropenia – 20 percent

Thrombocytopenia – 22.9 percent

Shortness of breath – 20 percent

Nausea – 14.3 percent

Vomiting – 14.3 Percent

Nervous system toxicity – 2.9 percent

Diarrhea – 2.9 percent

Fatigue – none

Mucositis (inflammation and sores on the mouth and the mucous membrane
lining the gastrointestinal tract) and skin rash were rare, occurring
in less than 10 percent of patients.

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